Articles : Treating Hypertension: Anger - the Missing Ingredient

By: Dr. Satya Bellerose

By now, the risks of hypertension to our health (stroke, heart disease, kidney disease, erectile problems, etc.) are well known. Doctors routinely monitor the risk factors for hypertension and encourage us to decrease salt intake, eat a healthy diet, exercise regularly, keep alcohol consumption low, refrain from smoking, lose weight if needed and reduce our stress. However, one of the biggest risk factors for hypertension and heart disease rarely gets attention despite excellent research dating over several decades that demonstrate its role. The missing ingredient is anger which can be expressed as hostility (an enduring disposition or state) or aggression (either expressed or inhibited).

Early research (1950s) on anger's role in heart disease demonstrated that Type A personalities (time-pressured, competitive, aggressive) had much more heart disease than Type B's (patient, relaxed, easy-going). Subsequent research clearly showed that the toxic core was hostility and aggression, not the other elements of the Type A behavior. This anger can be shown in many ways ranging from a cynical attitude, to lashing out verbally or physically.

Lifestyle modification is the recommended treatment for mild hypertension. Medication and lifestyle modification are needed for moderate or severe hypertension. If your family views you as an angry person, or if you find yourself frequently irritated, fuming or lashing out at others, you are a candidate for heart disease and hypertension.

Therapy for hypertension includes several components: relaxation and biofeedback to bring the nervous system into a more balanced state; cognitive behavior therapy and anger management to learn new ways to handle emotions and if trauma is present, EMDR or other techniques to resolve distress. Research demonstrated that therapy is very effective.

Case Studies:

Susan, a young woman in her 30's sought therapy for mild (grade 1) hypertension. Mild hypertension means the systolic pressure varies between 140-159 and/or diastolic pressure between 90-99. She had followed all the doctor's recommendations. She had decreased salt, improved her diet, exercised, and reduced her stress. In fact she had gotten into such good shape that she had run a marathon. However, she still had mild hypertension and did not want to take medication. When I asked her about anger, she said that she never got angry. When I asked her what happened when a driver cut her off in traffic, she replied that she cursed them vehemently in her head. An anger log kept over the next week revealed many incidents where she felt angry and frustrated. A brief therapy that included biofeedback, and anger management returned her blood pressure back to the normal range.

Ernie, a middle aged successful businessman, also sought therapy for hypertension because he did not wish to take medication which caused unpleasant side effects. However, he had severe hypertension (systolic 180+, diastolic 110+) which was only partially controlled by medication. While therapy can help reduce hypertension, it would not be a reasonable goal to expect to discontinue medication with severe hypertension. Ernie was already in good shape, attentive to his diet, exercised regularly and had never smoked. He was also very angry. He had multiple episodes of severe trauma in his life. Therapy began with biofeedback and stress management and then continued with traditional psychotherapy for trauma. Over a three year period, he made significant lifestyle changes, he began communicating his needs better, prioritizing his work responsibilities, he had a daily meditation practice and he resolved things that previously distressed him. At follow-up, Ernie reported that he was off all hypertensive medication and his blood pressure was in the normal/high normal range. This was an unusually good outcome, but Ernie was also a very determined person.

These cases demonstrate why managing anger effectively is important in controlling hypertension. Therapy for anger management should be a routine part of treatment of hypertension.

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